New study shows new potential treatment for pre-eclampsia

A new study from researchers at Cedars-Sinai in Los Angeles has found a molecular driver of pre-eclampsia, as well as a potential new treatment for the life-threatening condition that can occur during pregnancy.

Key Takeaways:

• Pre-eclampsia is a life-threatening health condition that can occur during pregnancy due to high blood pressure and the overproduction of a specific protein.

• The study found that a malfunctioning placenta causes the overproduction of a protein that leads to high blood pressure.

• A blood filtering system utilizes a monoclonal antibody to filter the blood out of the body, bind the protein and remove it, before sending the blood back into the body.

• Results were promising, but more research is needed.

The Details:

When left untreated, high blood pressure during pregnancy can escalate to pre-eclampsia, and ultimately, HELLP syndrome, which can be life-threatening to both mother and child.

According to the World Health Organization, between 5% to 8% of pregnancies are affected by pre-eclampsia in the United States each year. It contributes to 700-1,200 maternal deaths annually, according to the Centers for Disease Control and Prevention. Treatment has historically been to deliver the baby, often prematurely.

Now, a small study published in Nature Medicine last month shows that a new treatment targeting the cause of pre-eclampsia, rather than the symptoms, is showing promise.

Dr. Ananth Karumanchi, director of the Renovascular Research Center at Cedars-Sinai, said that there is a theory that preeclampsia is caused by a malfunctioning placenta that is producing high amounts of the protein sFlt-1. This leads to toxicity. Karumanchi said that developing a drug to target the protein would mean testing a drug on pregnant women, something doctors are typically hesitant to do because of the unknown risks and side effects.

Instead, researchers created a monoclonal antibody that would bind to the protein. By using a machine to temporarily remove blood from patients, they could filter the protein out of the blood and return the blood to the patients.

“This way, we [didn’t] have to worry about anything crossing the placenta, and we could turn off the machine if a woman had a complication,” said researcher Ravi Thadhani.

The process was carried out first on baboons, and then on five non-pregnant volunteers before being tried on pregnant women who had been admitted to the hospital for pre-eclampsia. The treatment took about two hours.

Researchers found that protein levels dropped by about 17%, and resulted in lowered blood pressure. The women in the study were able to delay birth for a median of 10 days, which was double what the doctors had expected.

Zoom Out:

In another recent study regarding pre-eclampsia, researchers found that abnormal blood vessel development, which is associated with pre-eclampsia, is driven down by turning off the VGLL3 gene. In pregnant mice, researchers found that an over-expression of VGLL3 caused elevated blood pressure.

When attempted on human placental biopsies from women with pre-eclampsia, researchers "found we were able to normalize, or even reverse, features of pre-eclampsia," said lead researcher, Dr. Johann Gudjonsson.

The Bottom Line:

While Karumanchi called the blood filtering results "exciting," more research is needed.

"We need to do a formal regulatory study ... like a standard, controlled trial, where we do treatment versus no treatment," he said.

As for the gene expression study, the long-term goal is to move the research to real-world treatments.